More than 42,000 policyholders in New Jersey health insurance plans will be getting small refunds, courtesy of a federal law that prevents insurers from overcharging for coverage.

The so-called 80/20 rule, part of the Affordable Care Act, makes insurance carriers issue refunds if they don’t spend at least 80 percent of the money from premiums on medical expenses instead of administrative costs and profits.

In New Jersey’s case, the refunds to be issued this summer total $3,434,390, or about $142 per policyholder, according to the U.S. Department of Health and Human Services.
Most of those refunds — $2,337,487 — will be going to policyholders of Nippon Life Insurance Company of America, a company that provides health insurance plans to corporate customers for their employees.

Customers of Monumental Life Insurance Company will receive $144,602 in refunds, while those of Oxford Health Plans (NJ), Inc will receive $932,301.

While the refunds are touted by HHS as being the result of Obamacare, they have been common practice in New Jersey, which has had its own version of the law in place for years.

"This is really nothing new in New Jersey," said Ward Sanders of the New Jersey Association of Health Plans, the trade group representing insurers. "We’ve had this law since 1992. Sometimes there are refunds, sometimes there are not. But in any event, it’s a couple of grains of sand compared to what is paid out in claims." Insurers here paid out an estimated $8.8 billion in claims last year, according to association figures.

If insurers don’t spend enough premium dollars on patient care and quality improvement, they must send consumers a refund in the mail, a lump-sum reimbursement to their account, or a credit that can be applied to future premiums. If the refund goes to an employer, it must be used to improve health coverage.

Nationwide, 6.8 million consumers will receive $330 million in refunds, for an average of $80 per family, according to HHS data.